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Am Fam Physician. 2008;77(4):527-528

Background: Poor communication skills in the physician-patient relationship are associated with lower patient satisfaction and more patient complaints. Although communications training has been introduced into medical education, assessment of skills lagged until recently. New U.S. and Canadian medical school graduates must pass an observed multiple-case standardized patient assessment (clinical skills examination [CSE]). One way of assessing whether performance on the CSE carries over into clinical practice is to correlate CSE scores with patient complaints. This study of Canadian medical school graduates investigated the ability of CSE scores to predict patient complaints surrounding issues of communication and quality of care.

The Study: The study used a Canadian system that allows patients to submit a written complaint about their physician to a medical regulatory authority. Data from physicians were linked to different types of complaints, which were classified as problems related to communication and attitude; quality of care; professionalism; office-related; physician health-related behavior problem (e.g., mental illness); or other. The primary outcome measure was the number of complaints per year of practice. The secondary outcome was the complaint rate related specifically to communication and quality of care problems. Performance on a traditional licensing examination and a case-based clinical skills examination using standardized patients was correlated with the calculated complaint rate.

Results: Over a mean follow-up time of 6.5 years (standard deviation = 2.4), one or more complaints were filed against 21.5 percent of the 3,424 physicians in the study. Of the 1,116 total filed complaints, 696 were retained. Most of the complaints (81.9 percent) related to communication issues.

Low CSE communication scores were associated with higher complaint rates. After adjustment for specialty and geographic factors, physicians in the lowest communication score quartile had an excess complaint rate of 1.75 per 100 practice-years compared with physicians in the top score quartile (adjusted relative risk [RR] = 1.52; 95% confidence interval [CI], 1.30 to 1.78), and an excess complaint rate of 2.15 per 100 practice-years compared with the upper three quartiles (adjusted RR = 1.43; 95% CI, 1.22 to 1.68). Other important correlations are listed in the accompanying table.

Test scoreCorrelation with complaints
Communication scoreSignificantly associated with complaint rate, most strongly with communication complaints
CSE data acquisition, problem-solving scoreNo relationship with complaints
Traditional written examination score (especially clinical decision-making score)Positive association with complaints
Multiple-choice scoreCorrelation with overall complaints, but not complaints regarding communication or quality of care

Conclusion: Communication scores on a licensing test predicted future patient complaints, especially among the lowest-scoring test-takers. In addition, clinical decision-making scores correlated with patient complaints. The authors suggest improving assessment of these skills, integrating their assessment into earlier stages of training, and investigating successful means of remediating deficiencies in these areas.

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